Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives

Abstract

Coronary microcirculation is disturbed in patients with arterial hypertension. Carotid intima-media thickness (IMT) and arterial stiffness are markers of subclinical atherosclerosis with prognostic significance. We investigated whether the combination of increased carotid IMT and arterial stiffness has a greater predictive value for the presence of impaired coronary flow reserve (CFR) than each index alone in never-treated hypertensives. We studied 110 untreated patients (age: 54.5±12 years) with newly diagnosed arterial hypertension. We measured (1) carotid-to-femoral artery pulse wave velocity (PWV), (2) carotid IMT and (3) CFR by means of color-guided Doppler echocardiography after adenosine infusion. Among other confounders, arterial stiffness and IMT were independent determinants of CFR (coefficient B¼À0.146 and B¼À0.006, Po0.05). Arterial stiffness and IMT had an incremental value for the determination of CFR when added to a model including other confounders (v 2 change¼4.423, P for change¼0.038 after addition of IMT; and v 2 change¼5.369, P for change¼0.020 after addition of PWV). Receiver operating curve analysis showed that PWV410.2 m s À1 and IMT41 mm were the optimal cutoff values to predict a CFRo2.5. Patients with IMT41 mm, PWV410.2 m s À1 or their combination had an odds ratio of 3.5, 5.0 and 11.2, Po0.05, for a CFRo2.5, respectively. The combination of increased carotid IMT and arterial stiffness has a greater predictive value for impaired CFR than each index alone in never-treated hypertensives.

Silent brain infarct is independently associated with arterial stiffness indicated by cardio-ankle vascular index (CAVI)

“…This correlation indicates that both CCAIMT and CAVI are associated with early atherosclerotic changes (arterial stiffness). 21,34 Carotid intima-media thickness is also a useful and non-invasive method to examine atherosclerosis and is associated with future stroke risk. 2,3,34 There were several limitations to this study.…”

Increased arterial stiffness in obstructive sleep apnea: a systematic review

“…37 This result is in line with another study, which showed that arterial stiffness is an independent predictor of vascular health and coronary artery disease above and beyond intima-media thickness. 38 Arterial stiffness increases chronically with age, with the development of chronic conditions (for example, hypertension), and with the presence of vascular risk factors (for example, smoking). [39][40][41] These observations have prompted researchers investigating OSAcardiovascular interactions to study the role of OSA in increasing arterial stiffness.…”

Arterial stiffness and carotid intima–media thickness: together they stand

“…6 This global approach to arterial function, 9 in addition to potentially solidifying the concepts elaborated in the study by Tzortis et al, 3 could further improve risk stratification for impaired CFR. Furthermore, it is interesting to consider that certain types of antihypertensive drugs improve CFR beyond what would be expected solely on the basis of a reduction in blood pressure.…”

“…[4][5][6] Interestingly, aortic stiffness has an independent predictive role not only for all-cause mortality but also for coronary events. [4][5][6] Causal relationships explaining this role do exist, and the findings of Tzortzis et al 3 provide a link. Increased arterial stiffness increases the velocity of the incident and reflected pulse waves, which in turn shifts the pressure wave reflections from diastole to systole.…”

“…The study by Tzortzis et al 3 demonstrates that increased carotid IMT and arterial stiffness are independent and complementary determinants of impaired CFR in nevertreated patients with essential hypertension. These results reinforce the pathophysiological association of pulse wave velocity and IMT with cardiovascular events in several populations, such as hypertensive individuals, patients with coronary artery disease and apparently healthy individuals.…”